Donor Mini-Nephrectomy
at Rhode Island Hospital
Donor Mini-Nephrectomy Results in Less Post-op
Pain and Shorter Hospitalization
by Paul Morrissey, MD
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Mini-nephrectomy incisions
shown two weeks after surgery.
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One consequence of the wide acceptance of laparoscopic donor nephrectomy
has been the development of mini-approaches to open donor nephrectomy.
Donor mini-nephrectomy involves removing the donor kidney through
a small abdominal incision. In contrast to traditional kidney surgery
(using a 6-8 inch incision, overlying the rib cage), the mini-nephrectomy
is performed through a 3-4 inch incision on the abdomen (see photos
of our patient 2 weeks after surgery at right). The recovery time
is quicker with mini-nephrectomy compared with the traditional approach.
Mini-nephrectomy at Rhode Island Hospital
During a three-year period (July 2005-January 2005), 132 living
donor transplants were performed at Rhode Island Hospital. Originally,
all donor surgery was performed through a standard flank incision
(82 patients) with 30% requiring rib resection (Group I). Since
October 2005, all ODN were performed through a 3-4 inch anterior
incision (Group II). Over the same period, 22 donors had their kidney
removed laparoscopically (Group III).
Results
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A patient with focal segmental glomerulosclerosis
(FSGS) had both kidneys removed through bilateral mini-nephrectomy
incisions measuring 2.5 inches (7 centimeters).
|
There were no complications with mini-nephrectomy. No differences
were noted in the recipient's kidney function with any approach.
The donor's length of stay in the hospital ranged from 2-5 days
in all groups. The average length of stay was reduced for Groups
II and III compared with the traditional approach. No differences
were observed for length of stay, the need for pain medication or
return to work for the mini-nephrectomy compared with laparoscopic
nephrectomy.
|
Group
|
Donor Hospital Days
|
Delayed Graft Function
|
Recipient Creatinine
|
OR
Time
(hours)
|
| Traditional |
3.8
|
2
|
1.4
|
4.2
|
| Mini-Nephrectomy |
3.2
|
0
|
1.3
|
3.8
|
| Laparoscopic |
2.9
|
1
|
1.3
|
4.2
|
Summary
Mini-nephrectomy and laparoscopic donor nephrectomy are comparable
procedures. Mini-nephrectomy is a retroperitoneal operation, which
offers some advantages over the abdominal surgery required by laparoscopy.
Recovery time for the donors and return to full activity is the
same for both operations. Short-term benefits for the donor and
long-term results for the kidney recipient are identical. The location
of the incision (abdomen versus pubic region) is one of the few
significant differences.
For more information, call Rhode Island Hospital transplant
services at 401-444-8345.
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